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What You Must Know About Oral Ulcers

Those small lesions of oral ulcers that pop up in your mouth can be painful and irritating. Especially when we have important events about to happen, the stress and rough schedule might bring some oral ulcers with them. We discuss some of the causes and remedies we can use to deal with oral ulcers

What You Must Know About Oral Ulcers

Those small lesions of oral ulcers that pop up in your mouth can be painful and irritating. Especially when we have important events about to happen, the stress and rough schedule might bring some oral ulcers with them. We discuss some of the causes and remedies we can use to deal with oral ulcers

Oral ulcers are small, painful sores that appear in your mouth and then usually heal by themselves after a few days or weeks. Although they are quite uncomfortable and might hinder your speech, eating and even drinking, but they’re usually harmless in the long run. Among the different types of ulcers seen in a patient’s mouth the Recurrent aphthous stomatitis (RAS) is the most common type of ulcerative disease of the oral cavity. The term “aphthous” is derived from a Greek word “aphthae” which means ulceration.

According to different surveys, the estimated point prevalence of oral ulcers worldwide is 4%, with aphthous ulcers being the most common, affecting as many as 25% of the population worldwide.[1] Recurrent aphthous stomatitis (RAS) is a common condition of the oral mucosa that presents in patients who are otherwise healthy. It is characterized by multiple, erythematous, recurrent, small, round or ovoid ulcers with circumscribed margins, typically presenting first in childhood or adolescence.[2] [3]

WHO IS AT RISK

Some of the highest incidences are seen in the Indian subcontinent, southern France, and South America. Importantly, the incidence of oral cancer is rising in most populations, particularly in young women. In the United Kingdom, around 2500 cases of oral cavity cancers are seen every year.[4]

Women, adolescents, and people with a family history of mouth ulcers are at higher risk for developing mouth ulcers. Familial occurrence is common as 30-40% patients with RAS have another family member having the same complaint. According to a survey published in the Journal of Clinical and Experimental Dentistry, Females at 56.3% were more commonly affected with oral ulcers than males at 43.7%. Patients in the third and fourth decade were most commonly affected.[5]

TRIGGERS OF ORAL ULCERS

The etiology of recurrent aphthous stomatitis is uncertain, and both environmental and genetic factors are indicated. However, there are a number of triggers that have been associated with oral ulcers which may even overlap such as stress, trauma, infection, allergy, genetic predisposition, or nutritional deficiencies. [6] [7]

Mouth ulcers also can be a sign of systemic conditions that are more serious and may require medical treatment, such as; inflammatory bowel disease, diabetes mellitus, Behcet’s disease, HIV/AIDS and other immunological conditions.

SIGNS AND SYMPTOMS

Mouth ulcers are not contagious. Once an ulcer occurs there is intense or moderate pain and the ulcers mostly heal in 10-14 days for the more common type and more than 2 weeks for the severe type. Recurrence of the ulcers occurs in intervals within a year or over several years.[8] Oral ulcers usually appear in three main forms with their specific signs and symptoms;

Minor Aphthae: It is the most common type of ulcer seen in human population. These ulcers are shallow rounded with a diameter of 3mm to 6mm. They are usually one to six in number and last for a duration of 6 to 10 days without any scarring.

Major Aphthae: This is an uncommon form of ulcers usually seen at the dorsum of tongue or occasionally gingiva with a diameter of 1cm to 2cm. These ulcers are 1 to 3 in number and sometimes mimic malignant ulcer. Major ulcers persist for three to six weeks and often leave a scare with healing.

Herpetiform Aphthae: These are also comparatively less common. These are present on the non keratinized mucosa as pin point ulcers. These are found in dozens to hundreds in number usually 1mm to 2mm in size and heal without scaring in about 2 weeks time.

INVESTIGATING THE PROBLEM

Oral ulcers are usually self limiting but when they are interfering with your normal daily activities, it is better that you see your dentist right away. To determine the cause of mouth ulcers careful history and examination is required. Your dentist might carry out diagnostic tests if he suspects any underlying deficiency like Vitamin B or Iron or any other systemic condition like colic disease. Any other cause of recurrent ulcers like trauma from any restoration, sharp tooth cusp or ill fitting prostheses should also be ruled out.

In case you are undergoing proper treatment and the ulcer still does not respond to it, a biopsy of part of the ulcer and some of the surrounding tissue may be taken for histological examination and diagnosis to rule out any other serious condition.

TREATMENT/MANAGEMENT OF ULCERS

In majority of cases, the pain and discomfort from mouth ulcers will lessen in a few days and the ulcers will eventually disappear in about a week or two without any treatment. However, there are three basic guidelines to deal with a recurrent event of oral ulcers;

- It is important to rule out aphthous like ulcers associated with systemic disease. This might not be an emergency situation but still a dental consultation into finding the cause of recurrent ulcers can help rule out a systemic condition in time.

- Successful therapy of Recurrent Aphthous Stomatitis requires correct diagnosis which will help control the aetiological factors and avoid the recurrence of ulcers.

- The goal of treatment of such lesions should be the elimination of pain and discomfort of the patient. Besides that the treatment also focuses on shortening of the course of disease and helping the body to carry out uneventful healing of the ulcerative lesion.

Based on the following guidelines we divide the management of oral ulcers into three parts:

PREVENTION

Though the appearance of an ulcer may be inevitable, there are some steps that one can take to events of recurrence of ulceration. Avoid spicy or unhealthy foods that can either trigger or worsen symptoms of ulcers, regularly brush and floss your teeth to keep your the mouth clean and incase of any suspicious medication that causes ulcers consult your doctor about changing the medication.

A number of studies have shown that Psychological stress may play a role in the manifestation of Recurrent Aphthous Stomatitis; it may serve as a trigger or a modifying factor rather than being a cause of the disease.[9] Recent article published in Clujul Medical Journal showed that among the 122 female dental students evaluated the prevalence of RAS was around 14% and there was a strong relationship between psychological stress and RAS.[10] So in order to effectively cure the ulceration related to stress it is important to be aware of the problem and work on its permanent resolution.

SELF CARE

Once you get an oral ulcer which is causing pain and discomfort, you can use a few remedies to make the healing of ulcer pain free or even quicker. Get a protective paste from your pharmacist that may numb the ulcer specially when you are having lunch or have some commitment that involves continuous public speaking. Also avoid using dentifrice that contains sodium lauryl sulphate, as this may cause irritation to the ulcer.

As with the preventive measures, therapeutic steps also demand that you avoid hard, spicy and salty foods until the ulcer heals. Avoid smoking or taking hot beverages and also use a straw to drink cool drinks to avoid irritating the aphthous stomatitis.

Using a rinse of Saltwater with Baking Soda or an Antimicrobial mouthwash may speed up healing and prevent infection of the ulcer. But care should be taken as such mouthwash can cause staining of teeth if taken for a long time. Using over-the-counter benzocaine (topical anesthetic) products like Orajel or Anbesol, applying ice to canker sores and/or placing damp tea bags on your mouth ulcer are some of the other home based remedies that can help relieve the discomfort of oral ulcers.

CONSULT YOUR DENTIST

When the pain of ulcers is unbearable or for suspicious ulcers that persist longer than usual, you should always consult your dentist. After careful assessment and ruling out any local cause of traumatic ulceration, the dentist may prescribe you a course of stronger corticosteroids to help reduce pain and swelling, and speed up healing. Corticosteroids are available on prescription as tablets, mouthwash, paste or spray form but are not suitable for children under 12 years of age.

Several systemic drugs have been reported to help in RAS that does not respond to topical therapy. However, the use of systemic agents should only be initiated in specialist centers.

The good thing about recurrent aphtous stomatitis is that these ulcers tend to clear up on their own, and the pain associated with an ulcer typically disappears within a couple of days. Besides the home based remedies, there are a number of over the counter medications, topical pastes and solutions available which may help with reduction of pain and associated swelling, but they might not always be needed in order to have full recovery. It is important for a person to know his own condition well and look for the cause of his oral ulcers. If we can fix our dietary habits, maintain good oral hygiene and try to reduce the incidence of stress and anxiety in our daily routine, we can effectively manage to reduce the onset of such ulcers to a minimum possible level.

Allie Leon, Chief Fun Officer

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